Download Conservative Bankart Lesion

Conservative Bankart Lesion
Precautions:
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Avoid placing the joint capsule under stress by stretching into abduction or ER during the early phases of rehabilitation, until dynamic joint stability is restored.
Avoid activities in extreme ROM’s early in the rehabilitation process
Factors affecting recovery time:
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Severity of symptoms
Length of time instability has presented
Age and activity level of patient
ROM/strength status
Desired goals and activities
Phase I (Acute Motion Phase)
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Goals and requirements to progress to next phase:
oEstablish pain-free ROM
oDecrease pain and inflammation
oEstablish good scapulothoracic rhythm
oImprove proprioception
• Decrease Pain/Inflammation:
oSling as needed for comfort
oTherapeutic modalities (ice, compression, e-stim)
o Grade I/II joint mobilizations for pain control
o DO NOT STRETCH THE JOINT CAPSULE
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Range of Motion Exercises:
oGentle ROM only, no stretching
oPendulums
oRope and pulley exercises
- In the scapular plane as tolerated
oAAROM exercises
- Flexion
- IR/ER with arm abducted to 30 degrees
- Progress to 45 then to 90 degrees of abduction
- DO NOT PUSH INTO ER OR HORIZONTAL ABDUCTION OR COMBINED ER/
ABDUCTION
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Strengthening/Proprioception Exercises:
o Isometrics (arm at side)
- Flexion
- Abduction
- Extension
- IR (multi-angles)
- ER (scapular plane)
- Biceps
- Scapular retraction/protraction and elevation/depression
Initial Date 12/28/12
324 Roxbury Road
*
Rockford, IL 61107
*
Therapy Department 815.484.6990
o Rhythmic Stabilization
- ER/IR in scapular plane
- Flexion/extension at 100 degrees of flexion, 20 degrees of horizontal abduction
- Scapular protraction/retraction, shrugs, depression
o Weight shifts (CKC in scapular plane)
o Proprioceptive drills
Phase II (Intermediate Phase)
• Goals and requirements to progress to next phase:
oRegain and improve muscle strength
oNormalize arthrokinematics
oImprove proprioception
oImprove neuromuscular control of the shoulder complex
oNormal scapulothoracic rhythm with AROM below 90 degrees
• Initiate Isotonic Strengthening
• Emphasis on ER and Scapular Strengthening
oER/IR theraband exercises
oScaption with ER (full can)
oAbduction to 90 degrees
oSidelying ER to 45 degrees
oShoulder shrugs
oProne extension to neutral
oProne horizontal adduction
oProne rowing
oLower trapezius
oBiceps
oWall/table pushups
oTriceps
• Improve neuromuscular control of the Shoulder Complex
oInitiation of PNF
oRhythmic stabilization drills
- ER/IR at 90 degrees of abduction
- Flexion/extension/horizontal abduction (neutral rotation) at 100 degrees of flexion, and 20 degrees of horizontal abduction
- Progress to mid and end ROM
oProgress OKC program
- PNF
- Manual resistance ER (supine then sidelying,) prone row
- ER/IR using Theraband with stabilization
oProgress CKC exercises with rhythmic stabilization
- Wall stabilization on ball
- Static holds in pushup position on ball
- Pushup on rocker board
Initial Date 12/28/12
324 Roxbury Road * Rockford, IL 61107 * Therapy Department
815.484.6990
o Core stabilization
- Abdominal strengthening
- Trunk/low back strengthening
- Gluteal strengthening
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Modalities
o Continue as needed for pain control
Phase III (Advanced Strengthening Phase)
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Goals:
o Improve strength/power/endurance
o Improve neuromuscular control
- Enhance dynamic stabilization
o Prepare patient/athlete for activity
o Full/normal ROM
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Criteria to progress to Phase III:
o Full pain-free ROM
o No palpable tenderness
o Good to normal muscle strength and scapulothoracic rhythm through full ROM
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Strengthening (PRE’s):
o Continue previous exercises
o Progress to end-range stabilization
o Progress to full ROM strengthening
o Progress to bench press (upper arms to parallel to floor only)
o Progress to machine rowing and lat pull downs in restricted ROM
• Emphasize PNF
• Advanced neuromuscular control drills (for athletes):
o Pushups on ball or rockerboard with rhythmic stabilization
o Manual scapular control drills
• Endurance training:
oTimed bouts of exercise 30-60 seconds
o Increase reps
o Multiple bouts throughout day (3x)
• Initiate plyometric training:
o 2-hand drills
- Chest pass
- Side to side
- Overhead
o Progress to 1-hand drills
- 90/90 throws
- Wall dribbles
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Modalities:
o As needed
Initial Date 12/28/12
324 Roxbury Road
*
Rockford, IL 61107
*
Therapy Department 815.484.6990
Phase IV (Return to Activity Phase)
•Goals:
o Maintain optimal level of strength/power/endurance
o Progressively increase activity level to prepare patient/athlete for full functional return to activity/sport
• Criteria to progress to Phase IV:
o Full ROM
o No pain or palpable tenderness
o Satisfactory isokinetic test
o Satisfactory clinical exam
• Continue all exercises in Phase III
• Initiate Interval Sport Program (as appropriate)
•Modalities:
o As needed
Follow Up
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Isokinetic test
Progress Interval Program
Maintenance of Exercise Program
Adapted From:
1.) Brotzman SB, Wilk, KE. Clinical Orthopedic Rehabilitation Second Edition. Philadelphia: Mosby; 2003.
2.) Wilk, KE. Advanced Continuing Education Institute, LLC. Non-Operative Rehabilitation Atraumatic Shoulder Instability. 2004.
Initial Date 12/28/12
324 Roxbury Road * Rockford, IL 61107 * Therapy Department
815.484.6990